Geographic Variation of Gabapentinoids and Opioids in US Nursing Homes.
Heeyoon Jung, Jonggyu Baek, Kate L Lapane
PMID 42696808WHAT IT FOUND
Gabapentinoids were used by 13.4% of long-stay US nursing home residents, opioids by 9.1%, and both by 5.4%.
Opioid and combined use varied widely by region. Combined use may need monitoring for sedation and falls.
Key findings
01Gabapentinoids-only use was 13.4%, opioids-only use was 9.1%, and concurrent gabapentinoid and opioid use was 5.4% among long-stay nursing home residents.
02Concurrent gabapentinoid and opioid use ranged from 1.15% in Harlingen, Texas to 20.0% in Neenah, Wisconsin across hospital referral regions.
03Female sex, pain, chronic obstructive pulmonary disease, anxiety, and use of NSAIDs, antidepressants, or muscle relaxants were associated with higher use across all three medication groups. Alzheimer's disease or dementia and moderate cognitive impairment were associated with lower use across all groups.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data were a snapshot, so the study cannot show that geographic variation causes unsafe prescribing or that any medication strategy improves outcomes. Medication use was identified from claims, so the authors could not see the indication, prescriber intent, or why a drug was started. A resident was counted as a user if the drug supply covered the assessment date, which may miss short-term or intermittent use. Hospital referral region characteristics were from 2019 while the cohort was 2021, and pandemic-related changes may have misclassified regional factors. The analysis excluded hospice, comatose, missing data, and very small facilities or regions, so it may not apply to those settings. The study did not measure falls, sedation, respiratory depression, pain control, or pharmacist review, so it cannot show whether monitoring would reduce harm.
The easy way to misread this
Do not read the regional differences as proof that one prescribing pattern is unsafe or that gabapentinoids are safer than opioids. This study only measured whether residents had medication supply on the assessment date. It did not compare falls, sedation, respiratory depression, or pain control.